ArticleCureus2026
Giant Cell Tumor of the Distal Ulna in an Elderly Patient on Hemodialysis: Diagnostic Challenge and Surgical Management.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Giant cell tumor of bone is a locally aggressive tumor that usually affects the epiphyseal region of long bones in young adults. Involvement of the distal ulna is rare, and the diagnosis in elderly patients with end-stage chronic kidney disease may be difficult because brown tumors related to secondary hyperparathyroidism can mimic giant cell tumor radiologically and histologically. We report the case of a 69-year-old woman with end-stage chronic kidney disease on hemodialysis who was admitted for a painful and progressively enlarging mass on the ulnar border of the left wrist that had been present for six months. Standard radiographs showed a well-defined, expansile osteolytic lesion of the distal ulna involving the epiphysis and metaphysis, with cortical thinning and no obvious periosteal reaction. Surgical biopsy demonstrated a proliferation of mononuclear stromal cells associated with numerous osteoclast-like multinucleated giant cells, compatible with a giant cell tumor. Given the hemodialysis background, a brown tumor was discussed; however, serum calcium, phosphate, and parathyroid hormone levels were within normal limits, and histology favored a giant cell tumor. The extension workup showed no secondary localization. The patient underwent en bloc resection of the distal ulna according to a Darrach-type procedure, associated with flexor carpi ulnaris tenodesis to improve the stability of the ulnar stump. Histopathological examination of the surgical specimen confirmed the diagnosis. At eight months of follow-up, the outcome was favorable, with satisfactory wrist function, a stable radiographic appearance, and no clinical or radiological recurrence. This case highlights the importance of clinicobiological and histopathological correlation when evaluating a giant-cell-rich bone lesion in a dialysis patient. It also supports the value of distal ulna resection associated with soft-tissue stabilization as a pragmatic option in selected elderly patients.
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